Neonatal outcome after exposure to selective serotonin reuptake inhibitors late in pregnancy

Objectives. - To analyse neonatal effects after in utero selective serotonin reuptake inhibitors exposure and the pertinence of recommendations delivered by our team. Materials and methods. - We report a series of 27 pregnancies exposed late in pregnancy including the period of delivery, to the Selective Setotonin Reuptake Inhibitors (SSRI) and having been the subject of a call to the Regional Center of Pharmacovigilance of Tours (CRPV). Results. - Twenty-seven children were born without malformation. Twelve children were hospitalized because of prematurity (two), exposure to others drugs imposing particular surveillance (eight) or in view of abnormal neonatal effects (two). Five newborns (18,5%) of which three had also been exposed to others drugs (benzodiazepine, neuroleptic, H1-antagonist) had presented one or more neonatal adverse effects compatible with the role of the SSRI (irritability, agitation, shivering, hypotonia) but with uncertainty about a clear discrimination between withdrawal syndrome and serotonin impregnation. All the symptoms disapeared spontaneously. One of the five children had a described in treated adults but two neonatal observations were published. No child had hemorrhagic symptoms as described in treated adults despite the fact that two neonatal observations were reported. Conclusion. - This study confirms the relative benignity of SSRI exposure during the late pregnancy. Our recommendations for monitoring the newborns during their stay in maternity were well respected. The risk of hemorrhagic symptoms or hyponatremia, not well known by pediatricians, deserves to be recalled to medical teams who take in charge newborns exposed to SSRI. (c) 2005 Elsevier SAS. Tons droits reserves.